Individual provider Active NPI

Paul Busse, M.D.

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1740520741
Registry record updated Dec 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME132632 Issued in FL
Practice address
10175 Fortune Pkwy Unit 204
Jacksonville, FL 32256-6748
Phone
(904) 619-3609
Fax
(904) 900-2225
NPI assigned
Feb 27, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME132632 FL Primary

Addresses

Primary practice location

10175 Fortune Pkwy Unit 204
Jacksonville, FL 32256-6748

Mailing address

10175 Fortune Pkwy Unit 204
Jacksonville, FL 32256-6748
Phone (904) 619-3609

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170921000382 FL Practitioner - Family Practice 5597996124 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Integra Concierge Medicine Family Medicine CurrentSince Nov 8, 2025 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jul 8, 2017 Accepting new patients
St Vincents Ambulatory Care Inc CurrentSince Jul 8, 2017 Accepting new patients

Locations

4205 Belfort Rd
Ste 4015
Jacksonville, FL 32216
Phone (904) 296-5691

10175 Fortune Pkwy
Unit 204
Jacksonville, FL 32256
Phone (904) 619-3609

2851 County Road 210 W
Ste 122
Saint Johns, FL 32259
Phone (904) 450-8120

2001 County Road 210 W
Ste 200
St Johns, FL 32259
Phone (904) 450-8120

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766793600000",
    "number": "1740520741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 FORTUNE PKWY UNIT 204",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566748",
            "telephone_number": "904-619-3609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 FORTUNE PKWY UNIT 204",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566748",
            "telephone_number": "904-619-3609",
            "fax_number": "904-900-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSSE",
        "first_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-27",
        "last_updated": "2025-12-27",
        "certification_date": "2025-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME132632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.